March 20, 2011 4:33 PM
Posted by: RedaChouffani
For many years, we have known that physicians and health care providers in general need to utilize an electronic health record (EHR) system to ensure that patient information is readily available anytime, and from anywhere. Not only does it make medical data widely available, but it also assists in clinical decision support, and we are reminded daily of the value to both patients and care givers alike. But the minute we start to consider the information that lives outside of the walls of the organization, we realize that not everyone uses the same data in the same way, or through the same tools — unless, that is, you are operating under one unified system.
As we see organizations beginning to review the Accountable Care Organization (ACO) model, it becomes clear that we may need to find a different, more efficient way to collaborate and coordinate care. A method that will make it easier on everyone to access health related information of a patient, from several sources and in different formats, without the need to learn multiple products. The current models available will prove to be challenging for everyone, unless, of course, they invest heavily into a community based HIE or advanced interfaces. And it is to be expected that we will have physician led ACOs who may not use a common platform for their patient health records, and may still find difficulties in getting specific pieces of information that an HIE might not provide immediately (imaging, for example).
This past week, I was attending a session presented by the head of healthcare at Salesforce.com. It was a great presentation that covered cloud computing, or to be exact, “Cloud 2 for health care.” This session was offered by The North Carolina Healthcare Information and Communications Alliance Inc. (NCHICA) and boasted several local CIOs and healthcare professionals in attendance. During the presentation, presenter Dave King discussed some of the incredible statistics on both the growth and impact that companies and products, such as Facebook.com and Apple’s iPad, respectively, have achieved. He also described how such new platforms and products changed the way that we both communicate and interact with mobile devices. It was during that very moment that I wondered: will healthcare see a similar paradigm shift when dealing with electronic medical records (EMRs)?.
I started to imagine a cloud based application that was similar to Facebook, but patient-centric. Think of a website such as PatientBooksdotcom.us (of course, this name is already taken). Such an idea (and not necessarily a good one either) which would increase adoption of collaborative tools, would share Facebook’s same basic ease of use, with a few, simple modifications to it which allow more direct collaboration on patient care. I would envision the capabilities being as follows:
· Video conferencing capabilities to allow care givers to collaborate (this functionality can be adopted from some of the existing third party providers for video/audio conferencing).
· Document sharing capabilities with easy to use search functionality (DICOM, Jpg/PDF/and anything that maybe used to help diagnose and care for patients).
· Announcements and discussions sections.
· Real-time integration with HIE to make available lab results, soap notes, medication list, problem list, etc..
· An option to publish selected data to a PHR (information that can be tagged or shared with Patient Health Information).
· The system must be available from anywhere at anytime.
· Easy to use interface.
· Extendable and open architecture.
· Exposed APIs to encourage add-on development.
· Strong security to protect patient data.
· The platform can be hosted in private/public cloud (this will allow communities to host their own collaboration platform)
· Accessibility through mobile platforms
· And best of all if it can be open source (wishful thinking to reduce cost and encourage innovation).
The intent is to facilitate the collaboration on patient care. As changes continue to come through different mandates, technology must continue to be an enabler for the market place. And while the PatientBookdotcome.us is not an existing product, some similar concepts have been introduced to the market, one of which is Voyant Health (a web portal for orthopedics surgeons and radiologist can collaborate and share images outside the clinics, est. in 2010).
I am confident that the market will see incredible innovations and new tools will continue to be developed to facilitate patient care as well as care provider’s collaboration.
March 20, 2011 4:29 PM
Posted by: RedaChouffani
, Customer relationship Manager
For many years companies across different markets have adopted some sort of Customer Relationship Management (CRM). These products have helped companies’ track opportunities for new business, it also assisted in standardizing workflows, as well as tracking follow-ups as part of the overall cycle of prospects to clients.
With the ability to capture sales information and provide analysis tools, these products have been a critical piece for many customer service departments and business development teams. And we have seen an increasing number of hospitals turn to these tools to help them track several key pieces of information and identify an outcome measure for their marketing efforts.
It is not uncommon to see a hospital or IDN needing to “Sell” services since what they really do is provide patient care reactively once a patient is sick and is admitted. With the shrinking reimbursements, increased competition and increasing operational costs, hospitals must attempt to win more new “clients” or patients over.
CRM’s value comes in many different flavors in the healthcare setting:
· Tracking patient’s feedback and measuring patient satisfaction through survey responses
· Tracking the outcome of campaigns (phone, mailers, online ads) and applying BI and linking new patients to the different campaigns.
· Streamlining the process of converting prospects to clients (Patients)
· Tracking referrals from different sources (While ensuring that the hospital is inline with the current regulations associated with referrals and kick backs).
· Keeping patients informed of new physicians, new specialties, new procedures and new physician practices through mailers and newsletters.
· Improving patient satisfaction through automated follow up activities after discharge
As search engines continue to be one of many places patients first turn to for medical advice, hospitals must ensure they have a strong online presences and employ creative ways to draw patients to their doors.But in order to succeed and better track the outcomes of these efforts they must utilize a CRM products to help maximize the conversion rate of prospects to patients.
March 13, 2011 11:03 PM
Posted by: RedaChouffani
During a recent hospital visit, I noticed a set of commonly used mobile computers, referred to as COWS (computers on wheels), moving around the halls of the cardiology floor. These very useful, and mobile, PCs were being used to document patient care and track inventory.
The COWS were made simply of a Wyse station that had wireless connectivity to a Citrix Presentation server, mounted on a moving platform, which had batteries connected to the bottom of it. These units were being rolled in front of the patient rooms, where the nurses would then scan a patient’s bracelet to ensure their identity, giving them the ability to track and verify medications and decrease chance of error.
But if the functionality needed from these units is simply the need to have connectivity to a terminal server, could a VMware platform for VDI (Virtual Desktop) or a Citrix server or tablet device do the trick instead, while possibly providing added value?
The following are some of the functionality and features that tablets might have over thin clients that are available on the COW units:
· Mobility: In the sense that when patients are receiving visitors and you can’t drag the COWS in the room, a tablet can be undocked and then taken to the patient’s bedside to read their bracelet or tag to confirm their identity and collect data.
· Battery life: Currently COWS require more power than a tablet device. In several of the new tablets, the battery life extends on average six to eight hours.
· Versatile: A tablet can be used to capture vitals by simply connecting through Bluetooth or wireless connectivity to some of the medical equipment. It can also assist hospitals reduce operational costs by reducing some of the paper based data entry.
The truth is that we can’t simply just venture off and assume these devices can replace the current COWS. In theory, they have a lot to offer, but one must take careful steps in evaluating this technology. There are still areas that need to be defined, such as securing these devices, as well as ensuring that their value has actual ROI for the hospitals that are using them. We must also understand the limitation of these tablets, which will become clearer as we continue down the road toward mobile health and remote patient monitoring.
March 13, 2011 10:27 PM
Posted by: RedaChouffani
This week has been a challenging week. A close member of my family underwent heart surgery. A quadruple bypass, this of course was a difficult event for everyone but after spending a week in Johnston City Medical center I have more questions than answers.
A decision to proceed with a quadruple bypass came quick. The need for this surgery came during a routine stent procedure to help with some blockage in the artery. The surgeon discussed the findings with the family and advised the patient about a plan of action that will reduce future risks of heart attack. But as we review the frequency of the bypass procedure and the overall costs associated with it, it was clear that this was a very common procedure for the hospital to perform. Based on statistics hospitals that perform these procedures have 25% to 40% of their revenue from this surgery.
With the on going conversation around healthcare reform and the use of other models of care (non fee-for-service) such as Accountable care organization, we can wonder what impact these changes would have on some of these hospitals?
How would hospitals adapt and shift to preventative care such as helping diabetic patients lead healthier lives, which would most likely reduce the likely hood of needing expensive surgeries (Lower coronary artery bypass surgery means lower profits).
This is of course would help drastically reduce healthcare costs for CMS, especially when Medicaid adds the additional projection subscribers that are the result of the recent healthcare reform in 2010.
It is without a doubt going to be a challenge as we move toward bundled payment systems that will only reward quality care, but this can also lead to more questions.
Is CMS going to handle differently the physician led ACO and hospital led one?
Are there going to be similar technical requirements for physician led ACO as Hospital led ones?
March 6, 2011 9:27 PM
Posted by: RedaChouffani
, mobile health
, secure data
I had recently been asked by a friend to assist in recovering data that was previously stored on a smartphone. I had plenty of disclaimers to provide, as I have had no prior experience with this type of phone, but when a friend is in distress, instincts kick in and I ended up doing some research on the matter.
Within hours, I was able to identify several tools that helped with this issue, and it was to my surprise, it was very easy to recover all data without even having the phone available!
With many of the smartphones used in the market place, end users tend to plug them into their PCs/Laptops to sync with their music and documents; this specific smartphone was no exception. Apparently the utility that comes with the phone allows a full — I mean “full” — backup of the entire phone to your PC.
Now that I found the backups of this smartphone and where they were sitting in the file system, it was just a matter of figuring out what how to make sense of any of the files.
The second item of business was to identify tools that can browse the actual backups. With the use of some widely available freeware utilities, I was able to simply browse to the backup folder, and then, voila! I was able to see all the backup files, and their full names (the backup replaced the original file names with unique identifiers).
The next step was to review all the files that were listed under his utilities, and to my surprise I was able to identify certain files, such as SMS (sms.db, cookies, websites, cached images,..etc.) With a little bit more research, I discovered that all the files with the extension db were nothing more than SQLLite files (flat database files). So I proceeded to download SQLLite database browser.
Sure enough, by simply viewing the sms.db file, the entire history of text messages (including the deleted ones) was available to me with no prior knowledge of passwords or access to the phone itself.
So what this mean to health care? Simply put, if you are a health care security administrator, or a physician, you will have the following concerns to deal with:
· Ensure that any patient related information is not stored permanently on the mobile phone
· Ensure that any backups that are being performed are encrypted and stored in the cloud securely and not on end user PCs
· Ensure that the mobile device is secured via passwords or patterns
· Keep in mind that if the device is lost or stolen then its data can easily be accessible
· Keep in mind that even when a laptop that was used to synchronized is lost or stolen then the data can also be jeopardized
My friend was able to gain access to the full contact list, call history, text messages and all images taken by the phone cam. There were some great lessons learned throughout this process. The bottom line, we all need to be aware that we must always question the security of the devices we may use and especially when it is dealing with patient information.
March 6, 2011 3:46 PM
Posted by: RedaChouffani
, Electronic Perscribing
In January 2009, the Centers for Medicare and Medicaid Services (CMS) established an incentive for providers who use a qualified e-prescribing system to submit their Medicare patients’ prescription electronically. This program was of course authorized by The Medicare Improvements for Patients and Providers Act (MIPAA) and became the law of the land on July 15th, 2008.
Fast forward to 2011. With the deadline looming this summer, there are a growing number of physicians who recognize that the penalties associated with not participating in this program stand to negatively impact their bottom lines. In response to the upcoming reductions in reimbursements that will be doled out to non-participating providers, several organizations are gearing up for some last minute attempts to meet the deadline of June 2011 — which stands to reduce payments by 1% of total Medicare Reimbursements should it not be met.
Organizations that have not participated in the e-prescribing program by June 30th of 2011 will face the following reduced payments:
1. Reimbursement reductions of total Medicare Payments
i. 2012 — 1%
ii. 2013 — 1.50%
iii. 2014 — 2%
iv. Subsequent years — 2%
2. Meaningful use delays: While the Medicare incentive may not be as significant as meaningful use ones, organizations who are not participating in this program may still find themselves without a system that can electronically prescribe, which most likely mean that they are not currently using a certified EHR that is required for Meaningful use.
The 2012 e-prescribing penalty will NOT apply to:
• A professional who is not a physician, nurse practitioner, or physician assistant as of June 30, 2011;
• A physician for whom office visits and other services listed in the CMS e-Prescribing measure specifications represent less than 10 percent of their allowed Medicare charges in the first six months of 2011; or
• A physician who has less than 100 claims for patient services containing visit and service codes that fall within the e-Prescribing measure specifications for dates of service between Jan. 1, 2011 through June 30, 2011
The requirements to participate in the incentive program are very strain forward. There are three steps:
1. Sign up qualified e-prescribing system: One of the simple ways to find out if your system has the ability to electronically prescribe is to visit Surescripts and identify if the product is listed in their certified products. If you are currently not using an EHR, you can select a stand-alone solution. You can find a list of available standalone packages here.
2. Submit G-Code G8553 in your superbill or encounter so that it is submitted via CMS 1500 or X12 837 claim file to the CMS (90801-9; 90862; 92002; 92004; 92012; 92014; 96150-2; 99201-5; 99211-5; 99304-10; 99315-16; 99341-5; 99347-50; G0101; G0108-9).
3. Ensure that you have at least 25 ambulatory visits and other applicable services for applicable CPT codes.
February 27, 2011 9:35 PM
Posted by: RedaChouffani
Accountable care organizations
, data exchange
With the federal government seeking to identify new ways — or trying older ways — to reform health care, Accountable Care Organizations (ACOs) have been one of the care delivery systems that our government is recommending as an option for improving patient care and reducing health care costs.
The ACO system typically consists of a variety of types of providers, from IDNs, hospitals, to primary care physicians, specialists, and potentially even nutritionists. With payment bundling and the coordination of care, these ACO members will have to work together and be collectively responsible for patient outcomes health improvements.
This would also mean that data must be exchanged electronically for all members in order truly have a coordinated care system. Not only this would facilitate the exchange of health information and medical records, but it would also stand to reduce or eliminate duplicate tests and other medical errors that some time occure due to lack of timely, electronically transmitted information.
There are still questions, of course, on where the data will reside. Since hospitals will be some of the most active participants, it may be easier to consider their infrastructure, actively seeking them to become the center spoke for the patient health records’ wheel. Regardless of the framework, there are many other questions to be asked and analysis to be performed to determine whether this model can in fact stand to improve health care outcomes and also reduce overall cost of care.
February 27, 2011 8:58 PM
Posted by: RedaChouffani
, Practice Fusion
This year during the HIMSS event there was a wide display of iPad users walking through the convention center halls as well as within the exhibitors booths. Vendors showcased some of their new mobility capabilities. Many have provided hands on demos of their electronic health records for all the excited visitors.
Some of the vendors who had some interesting examples of iPad App for their electronic health records are:
· GE Advance
· Practice Fusion
For GE the announcement of an iPad app comes at a good time since they are preparing to release a much-anticipated Centricity 10 for all their EHR users. For the most part many users who are planning on meaningful use have already upgraded their systems to 9.5, but with the new mobility functionality and the new features of 10.0 release, GE is bound to excite many of its prospects. It is still unclear what the pricing model for this will be and how the support will be delivered, especially for the smaller size practices who still continue to use third party resellers for their EHR support.
For Practice Fusion which offers a free web based EHR, offering an iPad app will boost its value proposition to physicians. Their recent collaboration with LogMeIn one of the top grossing third party Apps has help create an App that will enable full access to the chart. It is still unclear if the App in iPad will have any ability to interact with the built-in Cam, or dictation, but for only 30 dollars, and a free EHR account it is certainly an attractive proposition.
iPad has most definitely been noticed much more during this years’ HIMSS event. During one of the largest healthcare conferences of the year, and with over 27,000 attendees, it is sure to continue to gain popularity in the healthcare market.
February 20, 2011 9:20 PM
Posted by: RedaChouffani
, virtual desktop
In recent months I have been asked on numerous occasions the same questions during the current state analysis in some EHR implementation projects. The question was: “what is the most effective solution to replacing/ upgrading all existing desktops in an environment?” There is no size fits all here. But one technology that is worth considering as a good solid option is: Virtual desktop.
There are several reasons why one should replace existing aging desktops with virtual ones:
Since Windows XP will no longer be supported and still many have delayed the upgrade due to the costly hardware requirements of Windows 7, a virtual environment is very appealing and cost effective since it will provide standardize virtual hardware across the board.
One value we can immediately see with VDI (Virtual Desktop infrastructure) is the reduction in desktop support and maintenance. We can also reap the benefits of centralized data and ease of backup and DR. While in some cases group policy would resolve the issue of ensuring that all critical data on desktops is being stored on a central repository with virtual desktop we eliminate that pain point since all is stored on a SAN.
With different applications come different hardware requirements. And with the virtual environment adding memory or storage has never been simpler. With just few clicks we can upgrade the memory and increase the storage capacity to meet the requirements of specific applications.
With all the pressures of HIPAA compliance and the need to secure the health records in a healthcare environment, VDI mitigates some of the risks associated with data breach. A VDI has the ability to lock down the image so that there is no access to USB on the desktop. It also ensures that nothing can get installed that is not approved by the administrators. Since the actual “desktop” unit does not store any data this means that if it is stolen there is no way for anyone to gain access to any.
Customized desktop images to meet the need of department
In most enterprise settings there is a standard image per department or teams. So when a new employee starts they are assigned a desktop. With a VDI environment we can use the same concept with the exception that this time the new employee is assigned a specific image with just few clicks.
Clearly there are several benefits to virtualization. Not only an IDN can centrally managed all the workstations but they can continue to focus on meaningful use and not on the mundane tasks related to desktop support. Of course traditionally Citrix had several of the benefits that virtualization has to offer, but with the some of the added benefits of Disaster recovery, data containment, ease of management, device independence it seems that VDI may just be what the doctor prescribed.